|
STENT DE PROMUS 3.50mm x 8mm
|
Facility
OP
|
$20,896.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2974866
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,850.88 |
| Max. Negotiated Rate |
$19,224.32 |
| Rate for Payer: Aetna Commercial |
$18,806.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,970.56
|
| Rate for Payer: Aetna Managed Medicare |
$5,850.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,582.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,448.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,030.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,074.88
|
| Rate for Payer: Cash Price |
$6,268.80
|
| Rate for Payer: Cigna Commercial |
$19,224.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,693.40
|
| Rate for Payer: Health EOS Commercial |
$18,597.44
|
| Rate for Payer: HFN Commercial |
$19,224.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,672.00
|
| Rate for Payer: Multiplan Commercial |
$16,716.80
|
| Rate for Payer: NAPHCARE Commercial |
$12,537.60
|
| Rate for Payer: Preferred Network Access Commercial |
$19,224.32
|
| Rate for Payer: Quartz Beloit One Network |
$10,239.04
|
| Rate for Payer: Quartz Commercial |
$13,582.40
|
| Rate for Payer: Quartz Medicare Advantage |
$12,537.60
|
| Rate for Payer: WEA Trust Commercial |
$11,492.80
|
| Rate for Payer: WPS Commercial |
$15,477.67
|
|
|
STENT DE PROMUS 4.00mm x 12mm
|
Facility
OP
|
$20,896.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2974865
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,850.88 |
| Max. Negotiated Rate |
$19,224.32 |
| Rate for Payer: Aetna Commercial |
$18,806.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,970.56
|
| Rate for Payer: Aetna Managed Medicare |
$5,850.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,582.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,448.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,030.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,074.88
|
| Rate for Payer: Cash Price |
$6,268.80
|
| Rate for Payer: Cigna Commercial |
$19,224.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,693.40
|
| Rate for Payer: Health EOS Commercial |
$18,597.44
|
| Rate for Payer: HFN Commercial |
$19,224.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,672.00
|
| Rate for Payer: Multiplan Commercial |
$16,716.80
|
| Rate for Payer: NAPHCARE Commercial |
$12,537.60
|
| Rate for Payer: Preferred Network Access Commercial |
$19,224.32
|
| Rate for Payer: Quartz Beloit One Network |
$10,239.04
|
| Rate for Payer: Quartz Commercial |
$13,582.40
|
| Rate for Payer: Quartz Medicare Advantage |
$12,537.60
|
| Rate for Payer: WEA Trust Commercial |
$11,492.80
|
| Rate for Payer: WPS Commercial |
$15,477.67
|
|
|
STENT DE PROMUS 4.00mm x 12mm
|
Facility
IP
|
$20,896.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2974865
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,239.04 |
| Max. Negotiated Rate |
$19,224.32 |
| Rate for Payer: Aetna Commercial |
$18,806.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,074.88
|
| Rate for Payer: Cash Price |
$6,268.80
|
| Rate for Payer: Cigna Commercial |
$19,224.32
|
| Rate for Payer: Health EOS Commercial |
$18,597.44
|
| Rate for Payer: HFN Commercial |
$19,224.32
|
| Rate for Payer: Multiplan Commercial |
$16,716.80
|
| Rate for Payer: NAPHCARE Commercial |
$12,537.60
|
| Rate for Payer: Preferred Network Access Commercial |
$19,224.32
|
| Rate for Payer: Quartz Beloit One Network |
$10,239.04
|
| Rate for Payer: Quartz Commercial |
$12,537.60
|
| Rate for Payer: WEA Trust Commercial |
$11,492.80
|
| Rate for Payer: WPS Commercial |
$15,477.67
|
|
|
STENT DE PROMUS 4.00mm x 16mm
|
Facility
IP
|
$20,896.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2974864
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,239.04 |
| Max. Negotiated Rate |
$19,224.32 |
| Rate for Payer: Aetna Commercial |
$18,806.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,074.88
|
| Rate for Payer: Cash Price |
$6,268.80
|
| Rate for Payer: Cigna Commercial |
$19,224.32
|
| Rate for Payer: Health EOS Commercial |
$18,597.44
|
| Rate for Payer: HFN Commercial |
$19,224.32
|
| Rate for Payer: Multiplan Commercial |
$16,716.80
|
| Rate for Payer: NAPHCARE Commercial |
$12,537.60
|
| Rate for Payer: Preferred Network Access Commercial |
$19,224.32
|
| Rate for Payer: Quartz Beloit One Network |
$10,239.04
|
| Rate for Payer: Quartz Commercial |
$12,537.60
|
| Rate for Payer: WEA Trust Commercial |
$11,492.80
|
| Rate for Payer: WPS Commercial |
$15,477.67
|
|
|
STENT DE PROMUS 4.00mm x 16mm
|
Facility
OP
|
$20,896.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2974864
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,850.88 |
| Max. Negotiated Rate |
$19,224.32 |
| Rate for Payer: Aetna Commercial |
$18,806.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,970.56
|
| Rate for Payer: Aetna Managed Medicare |
$5,850.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,582.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,448.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,030.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,074.88
|
| Rate for Payer: Cash Price |
$6,268.80
|
| Rate for Payer: Cigna Commercial |
$19,224.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,693.40
|
| Rate for Payer: Health EOS Commercial |
$18,597.44
|
| Rate for Payer: HFN Commercial |
$19,224.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,672.00
|
| Rate for Payer: Multiplan Commercial |
$16,716.80
|
| Rate for Payer: NAPHCARE Commercial |
$12,537.60
|
| Rate for Payer: Preferred Network Access Commercial |
$19,224.32
|
| Rate for Payer: Quartz Beloit One Network |
$10,239.04
|
| Rate for Payer: Quartz Commercial |
$13,582.40
|
| Rate for Payer: Quartz Medicare Advantage |
$12,537.60
|
| Rate for Payer: WEA Trust Commercial |
$11,492.80
|
| Rate for Payer: WPS Commercial |
$15,477.67
|
|
|
STENT DE PROMUS 4.00mm x 20mm
|
Facility
IP
|
$20,896.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2974863
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,239.04 |
| Max. Negotiated Rate |
$19,224.32 |
| Rate for Payer: Aetna Commercial |
$18,806.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,074.88
|
| Rate for Payer: Cash Price |
$6,268.80
|
| Rate for Payer: Cigna Commercial |
$19,224.32
|
| Rate for Payer: Health EOS Commercial |
$18,597.44
|
| Rate for Payer: HFN Commercial |
$19,224.32
|
| Rate for Payer: Multiplan Commercial |
$16,716.80
|
| Rate for Payer: NAPHCARE Commercial |
$12,537.60
|
| Rate for Payer: Preferred Network Access Commercial |
$19,224.32
|
| Rate for Payer: Quartz Beloit One Network |
$10,239.04
|
| Rate for Payer: Quartz Commercial |
$12,537.60
|
| Rate for Payer: WEA Trust Commercial |
$11,492.80
|
| Rate for Payer: WPS Commercial |
$15,477.67
|
|
|
STENT DE PROMUS 4.00mm x 20mm
|
Facility
OP
|
$20,896.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2974863
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,850.88 |
| Max. Negotiated Rate |
$19,224.32 |
| Rate for Payer: Aetna Commercial |
$18,806.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,970.56
|
| Rate for Payer: Aetna Managed Medicare |
$5,850.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,582.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,448.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,030.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,074.88
|
| Rate for Payer: Cash Price |
$6,268.80
|
| Rate for Payer: Cigna Commercial |
$19,224.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,693.40
|
| Rate for Payer: Health EOS Commercial |
$18,597.44
|
| Rate for Payer: HFN Commercial |
$19,224.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,672.00
|
| Rate for Payer: Multiplan Commercial |
$16,716.80
|
| Rate for Payer: NAPHCARE Commercial |
$12,537.60
|
| Rate for Payer: Preferred Network Access Commercial |
$19,224.32
|
| Rate for Payer: Quartz Beloit One Network |
$10,239.04
|
| Rate for Payer: Quartz Commercial |
$13,582.40
|
| Rate for Payer: Quartz Medicare Advantage |
$12,537.60
|
| Rate for Payer: WEA Trust Commercial |
$11,492.80
|
| Rate for Payer: WPS Commercial |
$15,477.67
|
|
|
STENT DE PROMUS 4.00mm x 24mm
|
Facility
IP
|
$20,896.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2974862
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,239.04 |
| Max. Negotiated Rate |
$19,224.32 |
| Rate for Payer: Aetna Commercial |
$18,806.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,074.88
|
| Rate for Payer: Cash Price |
$6,268.80
|
| Rate for Payer: Cigna Commercial |
$19,224.32
|
| Rate for Payer: Health EOS Commercial |
$18,597.44
|
| Rate for Payer: HFN Commercial |
$19,224.32
|
| Rate for Payer: Multiplan Commercial |
$16,716.80
|
| Rate for Payer: NAPHCARE Commercial |
$12,537.60
|
| Rate for Payer: Preferred Network Access Commercial |
$19,224.32
|
| Rate for Payer: Quartz Beloit One Network |
$10,239.04
|
| Rate for Payer: Quartz Commercial |
$12,537.60
|
| Rate for Payer: WEA Trust Commercial |
$11,492.80
|
| Rate for Payer: WPS Commercial |
$15,477.67
|
|
|
STENT DE PROMUS 4.00mm x 24mm
|
Facility
OP
|
$20,896.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2974862
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,850.88 |
| Max. Negotiated Rate |
$19,224.32 |
| Rate for Payer: Aetna Commercial |
$18,806.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,970.56
|
| Rate for Payer: Aetna Managed Medicare |
$5,850.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,582.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,448.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,030.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,074.88
|
| Rate for Payer: Cash Price |
$6,268.80
|
| Rate for Payer: Cigna Commercial |
$19,224.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,693.40
|
| Rate for Payer: Health EOS Commercial |
$18,597.44
|
| Rate for Payer: HFN Commercial |
$19,224.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,672.00
|
| Rate for Payer: Multiplan Commercial |
$16,716.80
|
| Rate for Payer: NAPHCARE Commercial |
$12,537.60
|
| Rate for Payer: Preferred Network Access Commercial |
$19,224.32
|
| Rate for Payer: Quartz Beloit One Network |
$10,239.04
|
| Rate for Payer: Quartz Commercial |
$13,582.40
|
| Rate for Payer: Quartz Medicare Advantage |
$12,537.60
|
| Rate for Payer: WEA Trust Commercial |
$11,492.80
|
| Rate for Payer: WPS Commercial |
$15,477.67
|
|
|
STENT DE PROMUS 4.00mm x 28mm
|
Facility
OP
|
$20,896.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2974861
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,850.88 |
| Max. Negotiated Rate |
$19,224.32 |
| Rate for Payer: Aetna Commercial |
$18,806.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,970.56
|
| Rate for Payer: Aetna Managed Medicare |
$5,850.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,582.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,448.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,030.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,074.88
|
| Rate for Payer: Cash Price |
$6,268.80
|
| Rate for Payer: Cigna Commercial |
$19,224.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,693.40
|
| Rate for Payer: Health EOS Commercial |
$18,597.44
|
| Rate for Payer: HFN Commercial |
$19,224.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,672.00
|
| Rate for Payer: Multiplan Commercial |
$16,716.80
|
| Rate for Payer: NAPHCARE Commercial |
$12,537.60
|
| Rate for Payer: Preferred Network Access Commercial |
$19,224.32
|
| Rate for Payer: Quartz Beloit One Network |
$10,239.04
|
| Rate for Payer: Quartz Commercial |
$13,582.40
|
| Rate for Payer: Quartz Medicare Advantage |
$12,537.60
|
| Rate for Payer: WEA Trust Commercial |
$11,492.80
|
| Rate for Payer: WPS Commercial |
$15,477.67
|
|
|
STENT DE PROMUS 4.00mm x 28mm
|
Facility
IP
|
$20,896.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2974861
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,239.04 |
| Max. Negotiated Rate |
$19,224.32 |
| Rate for Payer: Aetna Commercial |
$18,806.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,074.88
|
| Rate for Payer: Cash Price |
$6,268.80
|
| Rate for Payer: Cigna Commercial |
$19,224.32
|
| Rate for Payer: Health EOS Commercial |
$18,597.44
|
| Rate for Payer: HFN Commercial |
$19,224.32
|
| Rate for Payer: Multiplan Commercial |
$16,716.80
|
| Rate for Payer: NAPHCARE Commercial |
$12,537.60
|
| Rate for Payer: Preferred Network Access Commercial |
$19,224.32
|
| Rate for Payer: Quartz Beloit One Network |
$10,239.04
|
| Rate for Payer: Quartz Commercial |
$12,537.60
|
| Rate for Payer: WEA Trust Commercial |
$11,492.80
|
| Rate for Payer: WPS Commercial |
$15,477.67
|
|
|
STENT DE PROMUS 4.00mm x 8mm
|
Facility
OP
|
$20,896.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2974860
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,850.88 |
| Max. Negotiated Rate |
$19,224.32 |
| Rate for Payer: Aetna Commercial |
$18,806.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,970.56
|
| Rate for Payer: Aetna Managed Medicare |
$5,850.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,582.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,448.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,030.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,074.88
|
| Rate for Payer: Cash Price |
$6,268.80
|
| Rate for Payer: Cigna Commercial |
$19,224.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,693.40
|
| Rate for Payer: Health EOS Commercial |
$18,597.44
|
| Rate for Payer: HFN Commercial |
$19,224.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,672.00
|
| Rate for Payer: Multiplan Commercial |
$16,716.80
|
| Rate for Payer: NAPHCARE Commercial |
$12,537.60
|
| Rate for Payer: Preferred Network Access Commercial |
$19,224.32
|
| Rate for Payer: Quartz Beloit One Network |
$10,239.04
|
| Rate for Payer: Quartz Commercial |
$13,582.40
|
| Rate for Payer: Quartz Medicare Advantage |
$12,537.60
|
| Rate for Payer: WEA Trust Commercial |
$11,492.80
|
| Rate for Payer: WPS Commercial |
$15,477.67
|
|
|
STENT DE PROMUS 4.00mm x 8mm
|
Facility
IP
|
$20,896.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2974860
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,239.04 |
| Max. Negotiated Rate |
$19,224.32 |
| Rate for Payer: Aetna Commercial |
$18,806.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,074.88
|
| Rate for Payer: Cash Price |
$6,268.80
|
| Rate for Payer: Cigna Commercial |
$19,224.32
|
| Rate for Payer: Health EOS Commercial |
$18,597.44
|
| Rate for Payer: HFN Commercial |
$19,224.32
|
| Rate for Payer: Multiplan Commercial |
$16,716.80
|
| Rate for Payer: NAPHCARE Commercial |
$12,537.60
|
| Rate for Payer: Preferred Network Access Commercial |
$19,224.32
|
| Rate for Payer: Quartz Beloit One Network |
$10,239.04
|
| Rate for Payer: Quartz Commercial |
$12,537.60
|
| Rate for Payer: WEA Trust Commercial |
$11,492.80
|
| Rate for Payer: WPS Commercial |
$15,477.67
|
|
|
STENT DE PROMUS ELEMENT 3.0 X 32
|
Facility
OP
|
$7,318.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
3595494
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,049.04 |
| Max. Negotiated Rate |
$6,732.56 |
| Rate for Payer: Aetna Commercial |
$6,586.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,293.48
|
| Rate for Payer: Aetna Managed Medicare |
$2,049.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,756.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,659.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,512.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,878.54
|
| Rate for Payer: Cash Price |
$2,195.40
|
| Rate for Payer: Cigna Commercial |
$6,732.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,095.15
|
| Rate for Payer: Health EOS Commercial |
$6,513.02
|
| Rate for Payer: HFN Commercial |
$6,732.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,488.50
|
| Rate for Payer: Multiplan Commercial |
$5,854.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,390.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,732.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,585.82
|
| Rate for Payer: Quartz Commercial |
$4,756.70
|
| Rate for Payer: Quartz Medicare Advantage |
$4,390.80
|
| Rate for Payer: WEA Trust Commercial |
$4,024.90
|
| Rate for Payer: WPS Commercial |
$5,420.44
|
|
|
STENT DE PROMUS ELEMENT 3.0 X 32
|
Facility
IP
|
$7,318.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
3595494
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,585.82 |
| Max. Negotiated Rate |
$6,732.56 |
| Rate for Payer: Aetna Commercial |
$6,586.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,878.54
|
| Rate for Payer: Cash Price |
$2,195.40
|
| Rate for Payer: Cigna Commercial |
$6,732.56
|
| Rate for Payer: Health EOS Commercial |
$6,513.02
|
| Rate for Payer: HFN Commercial |
$6,732.56
|
| Rate for Payer: Multiplan Commercial |
$5,854.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,390.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,732.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,585.82
|
| Rate for Payer: Quartz Commercial |
$4,390.80
|
| Rate for Payer: WEA Trust Commercial |
$4,024.90
|
| Rate for Payer: WPS Commercial |
$5,420.44
|
|
|
STENT DE PROMUS ELEMENT 3.5 X 32
|
Facility
IP
|
$7,318.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
3595495
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,585.82 |
| Max. Negotiated Rate |
$6,732.56 |
| Rate for Payer: Aetna Commercial |
$6,586.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,878.54
|
| Rate for Payer: Cash Price |
$2,195.40
|
| Rate for Payer: Cigna Commercial |
$6,732.56
|
| Rate for Payer: Health EOS Commercial |
$6,513.02
|
| Rate for Payer: HFN Commercial |
$6,732.56
|
| Rate for Payer: Multiplan Commercial |
$5,854.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,390.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,732.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,585.82
|
| Rate for Payer: Quartz Commercial |
$4,390.80
|
| Rate for Payer: WEA Trust Commercial |
$4,024.90
|
| Rate for Payer: WPS Commercial |
$5,420.44
|
|
|
STENT DE PROMUS ELEMENT 3.5 X 32
|
Facility
OP
|
$7,318.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
3595495
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,049.04 |
| Max. Negotiated Rate |
$6,732.56 |
| Rate for Payer: Aetna Commercial |
$6,586.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,293.48
|
| Rate for Payer: Aetna Managed Medicare |
$2,049.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,756.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,659.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,512.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,878.54
|
| Rate for Payer: Cash Price |
$2,195.40
|
| Rate for Payer: Cigna Commercial |
$6,732.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,095.15
|
| Rate for Payer: Health EOS Commercial |
$6,513.02
|
| Rate for Payer: HFN Commercial |
$6,732.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,488.50
|
| Rate for Payer: Multiplan Commercial |
$5,854.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,390.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,732.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,585.82
|
| Rate for Payer: Quartz Commercial |
$4,756.70
|
| Rate for Payer: Quartz Medicare Advantage |
$4,390.80
|
| Rate for Payer: WEA Trust Commercial |
$4,024.90
|
| Rate for Payer: WPS Commercial |
$5,420.44
|
|
|
STENT DE PROMUS MR 2.50mm x 8mm
|
Facility
IP
|
$20,896.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2973859
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,239.04 |
| Max. Negotiated Rate |
$19,224.32 |
| Rate for Payer: Aetna Commercial |
$18,806.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,074.88
|
| Rate for Payer: Cash Price |
$6,268.80
|
| Rate for Payer: Cigna Commercial |
$19,224.32
|
| Rate for Payer: Health EOS Commercial |
$18,597.44
|
| Rate for Payer: HFN Commercial |
$19,224.32
|
| Rate for Payer: Multiplan Commercial |
$16,716.80
|
| Rate for Payer: NAPHCARE Commercial |
$12,537.60
|
| Rate for Payer: Preferred Network Access Commercial |
$19,224.32
|
| Rate for Payer: Quartz Beloit One Network |
$10,239.04
|
| Rate for Payer: Quartz Commercial |
$12,537.60
|
| Rate for Payer: WEA Trust Commercial |
$11,492.80
|
| Rate for Payer: WPS Commercial |
$15,477.67
|
|
|
STENT DE PROMUS MR 2.50mm x 8mm
|
Facility
OP
|
$20,896.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2973859
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,850.88 |
| Max. Negotiated Rate |
$19,224.32 |
| Rate for Payer: Aetna Commercial |
$18,806.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,970.56
|
| Rate for Payer: Aetna Managed Medicare |
$5,850.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,582.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,448.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,030.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,074.88
|
| Rate for Payer: Cash Price |
$6,268.80
|
| Rate for Payer: Cigna Commercial |
$19,224.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,693.40
|
| Rate for Payer: Health EOS Commercial |
$18,597.44
|
| Rate for Payer: HFN Commercial |
$19,224.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,672.00
|
| Rate for Payer: Multiplan Commercial |
$16,716.80
|
| Rate for Payer: NAPHCARE Commercial |
$12,537.60
|
| Rate for Payer: Preferred Network Access Commercial |
$19,224.32
|
| Rate for Payer: Quartz Beloit One Network |
$10,239.04
|
| Rate for Payer: Quartz Commercial |
$13,582.40
|
| Rate for Payer: Quartz Medicare Advantage |
$12,537.60
|
| Rate for Payer: WEA Trust Commercial |
$11,492.80
|
| Rate for Payer: WPS Commercial |
$15,477.67
|
|
|
STENT DUODENAL BEND PRELOADED ADVANIX 10FR X 12CM M00534350
|
Facility
OP
|
$2,125.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
3092798
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$595.00 |
| Max. Negotiated Rate |
$1,955.00 |
| Rate for Payer: Aetna Commercial |
$1,912.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,827.50
|
| Rate for Payer: Aetna Managed Medicare |
$595.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,381.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,062.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,020.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,126.25
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cigna Commercial |
$1,955.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,189.15
|
| Rate for Payer: Health EOS Commercial |
$1,891.25
|
| Rate for Payer: HFN Commercial |
$1,955.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,593.75
|
| Rate for Payer: Multiplan Commercial |
$1,700.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,275.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,955.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,041.25
|
| Rate for Payer: Quartz Commercial |
$1,381.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,275.00
|
| Rate for Payer: WEA Trust Commercial |
$1,168.75
|
| Rate for Payer: WPS Commercial |
$1,573.99
|
|
|
STENT DUODENAL BEND PRELOADED ADVANIX 10FR X 12CM M00534350
|
Facility
IP
|
$2,125.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
3092798
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,041.25 |
| Max. Negotiated Rate |
$1,955.00 |
| Rate for Payer: Aetna Commercial |
$1,912.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,126.25
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cigna Commercial |
$1,955.00
|
| Rate for Payer: Health EOS Commercial |
$1,891.25
|
| Rate for Payer: HFN Commercial |
$1,955.00
|
| Rate for Payer: Multiplan Commercial |
$1,700.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,275.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,955.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,041.25
|
| Rate for Payer: Quartz Commercial |
$1,275.00
|
| Rate for Payer: WEA Trust Commercial |
$1,168.75
|
| Rate for Payer: WPS Commercial |
$1,573.99
|
|
|
STENT DUODENAL BEND PRELOADED ADVANIX 10FR X 15CM
|
Facility
IP
|
$2,046.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
3092799
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,002.54 |
| Max. Negotiated Rate |
$1,882.32 |
| Rate for Payer: Aetna Commercial |
$1,841.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,084.38
|
| Rate for Payer: Cash Price |
$613.80
|
| Rate for Payer: Cigna Commercial |
$1,882.32
|
| Rate for Payer: Health EOS Commercial |
$1,820.94
|
| Rate for Payer: HFN Commercial |
$1,882.32
|
| Rate for Payer: Multiplan Commercial |
$1,636.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,227.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,882.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,002.54
|
| Rate for Payer: Quartz Commercial |
$1,227.60
|
| Rate for Payer: WEA Trust Commercial |
$1,125.30
|
| Rate for Payer: WPS Commercial |
$1,515.47
|
|
|
STENT DUODENAL BEND PRELOADED ADVANIX 10FR X 15CM
|
Facility
OP
|
$2,046.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
3092799
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$572.88 |
| Max. Negotiated Rate |
$1,882.32 |
| Rate for Payer: Aetna Commercial |
$1,841.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,759.56
|
| Rate for Payer: Aetna Managed Medicare |
$572.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,329.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,023.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$982.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,084.38
|
| Rate for Payer: Cash Price |
$613.80
|
| Rate for Payer: Cigna Commercial |
$1,882.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,144.94
|
| Rate for Payer: Health EOS Commercial |
$1,820.94
|
| Rate for Payer: HFN Commercial |
$1,882.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,534.50
|
| Rate for Payer: Multiplan Commercial |
$1,636.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,227.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,882.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,002.54
|
| Rate for Payer: Quartz Commercial |
$1,329.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,227.60
|
| Rate for Payer: WEA Trust Commercial |
$1,125.30
|
| Rate for Payer: WPS Commercial |
$1,515.47
|
|
|
STENT DUODENAL BEND PRELOADED ADVANIX 10FR X 5CM M00534320
|
Facility
IP
|
$2,046.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
3092795
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,002.54 |
| Max. Negotiated Rate |
$1,882.32 |
| Rate for Payer: Aetna Commercial |
$1,841.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,084.38
|
| Rate for Payer: Cash Price |
$613.80
|
| Rate for Payer: Cigna Commercial |
$1,882.32
|
| Rate for Payer: Health EOS Commercial |
$1,820.94
|
| Rate for Payer: HFN Commercial |
$1,882.32
|
| Rate for Payer: Multiplan Commercial |
$1,636.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,227.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,882.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,002.54
|
| Rate for Payer: Quartz Commercial |
$1,227.60
|
| Rate for Payer: WEA Trust Commercial |
$1,125.30
|
| Rate for Payer: WPS Commercial |
$1,515.47
|
|
|
STENT DUODENAL BEND PRELOADED ADVANIX 10FR X 5CM M00534320
|
Facility
OP
|
$2,046.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
3092795
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$572.88 |
| Max. Negotiated Rate |
$1,882.32 |
| Rate for Payer: Aetna Commercial |
$1,841.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,759.56
|
| Rate for Payer: Aetna Managed Medicare |
$572.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,329.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,023.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$982.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,084.38
|
| Rate for Payer: Cash Price |
$613.80
|
| Rate for Payer: Cigna Commercial |
$1,882.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,144.94
|
| Rate for Payer: Health EOS Commercial |
$1,820.94
|
| Rate for Payer: HFN Commercial |
$1,882.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,534.50
|
| Rate for Payer: Multiplan Commercial |
$1,636.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,227.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,882.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,002.54
|
| Rate for Payer: Quartz Commercial |
$1,329.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,227.60
|
| Rate for Payer: WEA Trust Commercial |
$1,125.30
|
| Rate for Payer: WPS Commercial |
$1,515.47
|
|
